Public reporting of hospital quality shows inconsistent ranking results

- Comparison of hospital recommendations on four German hospital report cards.
- A low level of ranking agreement between hospital report cards was shown.
- Only four of ten hospitals were labeled equally on two report cards.
- Increasing the concept of medical “quality” seems to be crucial.
- This would help patients compare and select the appropriate report card.

BackgroundEvidence from the US has demonstrated that hospital report cards might generate confusion for consumers who are searching for a hospital. So far, little is known regarding hospital ranking agreement on German report cards as well as underlying factors creating disagreement.ObjectiveThis study examined the consistency of hospital recommendations on German hospital report cards and discussed underlying reasons for differences.MethodsWe compared hospital recommendations for three procedures on four German hospital report cards. The agreement between two report cards was determined by Cohen's-Kappa. Fleiss' kappa was applied to evaluate the overlap across all four report cards.ResultsOverall, 43.40% of all hospitals were labeled equally as low, middle, or top performers on two report cards (hip replacement: 43.2%; knee replacement: 42.8%; percutaneous coronary intervention: 44.3%). In contrast, 8.5% of all hospitals were rated a top performer on one report card and a low performer on another report card. The inter-report card agreement was slight at best between two report cards (κmax = 0.148) and poor between all four report cards (κmax = 0.111).ConclusionsTo increase the benefit of public reporting, increasing the transparency about the concept of - medical - “quality” that is represented on each report card seems to be important. This would help patients and other consumers use the report cards that most represent one's individual preferences.